HIV and Immunizations

Vaccines protect people from diseases such as chicken pox, flu, and polio. Vaccines are given by needle injection (a shot), by mouth, or sprayed into the nose. The process of getting a vaccine is called vaccination or immunization.

There are no vaccines to prevent or cure HIV, but people with HIV can benefit from vaccines against other diseases. The following vaccines are recommended for all people with HIV: hepatitis B; influenza (flu); human papillomavirus (HPV) (for those up to age 26); pneumococcal (pneumonia); and tetanus, diphtheria, and pertussis (a single vaccine that protects against the three diseases). Every 10 years, a repeat vaccine against tetanus and diphtheria is also recommended. Other vaccines may be recommended for some people with HIV.

In general, people with HIV should not get live, attenuated vaccines unless the benefit outweighs the risk.

Because HIV medicines strengthen the immune system and reduce HIV viral load, whenever possible people with HIV may want to start taking HIV medicines before getting immunizations.

What Are Vaccines?

Vaccines protect people from diseases such as chicken pox, flu, and polio. Vaccines are given by needle injection (a shot), by mouth, or sprayed into the nose. The process of getting a vaccine is called vaccination or immunization.

Most vaccines are designed to prevent a person from ever having a particular disease or to result in a person having only a mild case of the disease. When a person gets a vaccine, the body responds by mounting an immune response against the particular disease. An immune response includes all the actions of the immune system to defend the body against the infection.

Vaccines not only protect individuals from disease, they protect communities as well. When most people in a community get immunized against a disease, there is little chance of a disease outbreak.

Even though there are no vaccines to prevent or cure HIV, people with HIV can benefit from vaccines against other diseases.

Can HIV Infection Affect the Safety and Effectiveness of Vaccines?

Yes. Damage to the immune system due to HIV can reduce the body's immune response to a vaccine. A weakened immune response makes a vaccine less effective. In general, vaccines work best when an HIV-infected person's CD4 count is above 200 copies/mm3.

By stimulating the immune system, vaccines may also cause a person's HIV viral load to increase temporarily.

Because HIV medicines strengthen the immune system and reduce HIV viral load, people with HIV may want to start antiretroviral therapy (ART) before getting vaccinated whenever possible. In some situations, however, immunizations should be given even if ART has not been started. For example, it's important for people with HIV to get vaccinated against the flu at the time of year when the risk of flu is greatest.

Are All Types of Vaccines Safe for People With HIV?

The design of a vaccine depends on several factors, such as how a microbe infects the body and how the immune system responds. For this reason, there are several types of vaccines, including live, attenuated vaccines and inactivated vaccines.

Live, Attenuated Vaccines

A live, attenuated vaccine contains a weakened but live form of a disease-causing microbe. Although the attenuated (weakened) microbe cannot cause the disease (or can cause only mild disease), the vaccine can still trigger an immune response.

Inactivated Vaccines

Inactivated vaccines are made from microbes that have been killed with chemicals, heat, or radiation. There is no chance that an inactivated vaccine can cause the disease it was designed to prevent.

In general, to be safe, people with HIV should get inactivated vaccines to avoid even the remote chance of getting a disease from a live, attenuated vaccine. However, for some diseases, only live, attenuated vaccines are available. In this case, the protection offered by the live vaccine may outweigh the risks. Vaccines against chicken pox and shingles are examples of live, attenuated vaccines that, in certain situations, may be recommended for people with HIV.

Do Vaccines Cause Side Effects?

Side effects from vaccines are generally minor (for example, soreness at the location of an injection or a low-grade fever) and go away within a few days. Severe reactions to vaccines are rare. Before getting a vaccine, talk to your health care provider about the benefits and risks of the vaccine and possible side effects.

Which Vaccines Are Recommended for People With HIV?

The following vaccines are recommended for people with HIV:

Hepatitis B

Influenza (flu)

Pneumococcal (pneumonia)

Tetanus, diphtheria, and pertussis (whooping cough). A single vaccine called Tdap protects adolescents and adults against the three diseases. Every 10 years, a repeat vaccine against tetanus and diphtheria (called Td) is recommended.

Human papillomavirus (HPV) (for those up to age 26)

Additional vaccines may be recommended based on an HIV-infected person's age, previous vaccinations, risk factors for a particular disease, or certain HIV-related factors. For more details, read this information from the Centers for Disease Control and Prevention (CDC): HIV Infection and Adult Vaccination.

What About Travel and Immunizations?

Regardless of destination, all travelers should be up to date on routine vaccinations. Those traveling to destinations outside the United States may need immunizations against diseases present in other parts of the world, such as cholera or yellow fever.

If you have HIV, talk to your health care provider about any vaccines you may need before you travel.

If a required immunization is available only as a live, attenuated vaccine, your health care provider can give you a letter that excuses you from getting the vaccine.

If your CD4 count is less than 200 copies/mm3, your health care provider may recommend that you delay travel to give your HIV medicines time to strengthen your immune system.

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